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This is VAERS ID 270365

Case Details

VAERS ID: 270365 (history)  
Age: 14.0  
Gender: Female  
Location: New York  
Vaccinated:2006-11-27
Onset:2006-11-28
   Days after vaccination:1
Submitted: 2007-01-10
   Days after onset:43
Entered: 2007-01-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB141AA / 0 - / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 09546 / 0 - / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1932AB / 0 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1052F / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Feeling hot, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Right deltoid erythematous, warm and tender.


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